MEDICARE: TAMMIE MARIE WIESNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	23257	NC

General Provider Information

NPI Number	:	1578498259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMIE MARIE WIESNER

Provider Business Mailing Address
First Line	:	409 LONDONDERRY DR
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-8318
Country	:	US
Telephone Number	:	910-674-1689
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 N MAIN ST
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-1833
Country	:	US
Telephone Number	:	910-491-2575
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ TAMMIE MARIE WIESNER ” Practice Location

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